Forensic Auditor

Responsibilities

The Auditor will work under the direction of the United States Attorneys / Department of Justice (DOJ) Assistant U.S. Attorneys within the Office. Assists the United States Attorney's Office (USAO) in the investigation and trial preparation phases by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex.

• Conduct audits in support of investigations and litigation involving the government's affirmative civil enforcement of federal laws, particularly:
  • False Claims Act, 31 U.S.C. §§3729-3733
  • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b)(1)(A)
  • Stark Law, 42 U.S.C. § 1395nn(a)
• Conduct similar audits in support of criminal investigations involving:
  • 18 U.S.C. § 641
  • 18 U.S.C. § 1343 (Wire Fraud)
  • 18 U.S.C. § 1341
  • 18 U.S.C. § 1347
  • 18 U.S.C. § 1956 (Laundering of monetary instruments)
  • 18 U.S.C. § 1957
• Review, analyze, and interpret complex data sets, including:
  • Centers for Medicare & Medicaid Services claims data
  • PPP loan data
  • Records associated with health care fraud, defense procurement fraud, and other government program fraud
• Identify outlier billings and other anomalies within health care claim codes and normalize claims data across multiple benefit plans to support time studies and other analytical assessments.
• Detect trends, patterns, and relevant information within investigative and discovery records and apply this analysis to test data under various conditions.
• Reinterpret and extrapolate results from Statistically Valid Random Samples when modifications to sample review outcomes occur.
• Develop, document, and defend loss calculation methodologies and financial damage models for litigation.
• Conduct financial investigations to assess the ability of individuals and organizations to satisfy settlements and judgments, including detailed analysis of:
  • Assets and liabilities
  • Debt covenants and borrowing capacity
  • Earnings and financial ratios
  • Aging schedules and tax considerations
  • Collectability
• Examine personal and business financial records to identify payments, kickbacks, money flows, sources and uses of cash, related-party transactions, and potential damages.
• Perform asset valuations, records reconstruction, and creation of computerized financial models for use in presentations of financial evidence.
• Prepare clear, accurate reports summarizing financial analyses, data findings, and evidentiary conclusions.
• Communicate investigative findings to attorneys, investigators, and other team members, and provide recommendations to DOJ / USAO Attorneys regarding investigative plans, areas of focus, and potential courses of action.
• Review defense presentations, expert reports, and related materials, and collaborate with independent experts as needed.
• Prepare expert reports for litigation and participate in negotiations upon request.
• Professionally engage with witnesses, persons of interest, and representatives of local, state, and federal agencies to obtain statements, clarify facts, and establish sequences of events in support of investigative objectives.
• Participate in the Suspicious Activity Report (SAR) Review Team, reviewing FINCEN reports to generate investigative leads for law enforcement and assisting in de-conflicting pending investigations.

Investigations may involve individually identifiable medical information, which the contractor will keep confidential, maintaining the privacy of individuals who received the health care services or items. Confidentiality will also be maintained for matters under seal, such as qui tam lawsuits, and matters occurring before the grand jury. Investigations may concern sensitive matters, involve prominent individuals, organizations, or corporations within a United States Attorney's district, all of which the investigator will keep confidential.

Requirements

• Must be a Certified Public Accountant (CPA).
• MBA or equivalent in accounting or a directly related field.
• Thorough knowledge of generally accepted accounting principles (GAAP) and generally accepted auditing standards (GAAS).
• Minimum of three years' experience as an auditor.
• Minimum two years specialized experience in the specific subject matter area involved (e.g., Medicare billing and claims systems, or DoD inventory systems).
• Working knowledge of appropriate accounting and financial analysis ADP systems and applications.

Skills

• Excellent oral and written communication skills.
• Experience in a litigation environment; experience working with automated litigation support is helpful.